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Contents lists available at ScienceDirect

Journal of Dermatological Science

journal homepage: www.jdsjournal.com

Review article

Cutaneous manifestations of COVID-19: Report of three cases and a

review of literature
Muskaan Sachdevaa,1, Raffaele Gianottib,c,1, Monica Shaha , Bradanini Luciad, Diego Tosie ,
Stefano Veraldic , Michael Zivf , Eyal Leshemg,h , Roni P. Dodiuk-Gadf,i,j,*
a
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
b
Institute of Dermatological Sciences, University of Milan, Italy
c
Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
d
Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
e
Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
f
Dermatology Department, Emek Medical Center, Israel
g
Institute for Travel and Tropical Medicine, Sheba Medical Centre, Israel
h
School of Medicine, Tel Aviv University, Israel
i
Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Israel
j
Department of Medicine, University of Toronto, Toronto, Ontario, Canada

A R T I C L E I N F O A B S T R A C T

Article history: Background: Various cutaneous manifestations have been observed in patients with COVID-19 infection.
Received 24 April 2020 However, overall similarities in the clinical presentation of these dermatological manifestations have not
Accepted 24 April 2020 yet been summarized.
Objective: This review aims to provide an overview of various cutaneous manifestations in patients with
Keywords: COVID-19 through three case reports and a literature review.
Cutaneous manifestations Methods: A literature search was conducted using PubMed, OVID, and Google search engines for original
COVID-19
and review articles. Studies written in the English language that mentioned cutaneous symptoms and
Skin
Review
COVID-19 were included.
Results: Eighteen articles and three additional cases reported in this paper were included in this review.
Of these studies, 6 are case series and 12 are case report studies. The most common cutaneous
manifestation of COVID-19 was found to be maculopapular exanthem (morbilliform), presenting in 36.1%
(26/72) patients. The other cutaneous manifestations included: a papulovesicular rash (34.7%, 25/72),
urticaria (9.7%, 7/72), painful acral red purple papules (15.3%, 11/72) of patients, livedo reticularis lesions
(2.8%, 2/72) and petechiae (1.4%, 1/72). Majority of lesions were localized on the trunk (66.7%, 50/72),
however, 19.4% (14/72) of patients experienced cutaneous manifestations in the hands and feet. Skin
lesion development occurred before the onset of respiratory symptoms or COVID-19 diagnosis in 12.5%
(9/72) of the patients, and lesions spontaneously healed in all patients within 10 days. Majority of the
studies reported no correlation between COVID-19 severity and skin lesions.
Conclusion: Infection with COVID-19 may result in dermatological manifestations with various clinical
presentations, which may aid in the timely diagnosis of this infection.
© 2020 Published by Elsevier B.V. on behalf of Japanese Society for Investigative Dermatology.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
2. Case 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3. Case 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
4. Case 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

* Corresponding author at: Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, 1 Efron St., Bat Galim Haifa, 3525433, Israel.
E-mail address: rdodiukgad@gmail.com (R.P. Dodiuk-Gad).
1
Equal contribution.

https://doi.org/10.1016/j.jdermsci.2020.04.011
0923-1811/ © 2020 Published by Elsevier B.V. on behalf of Japanese Society for Investigative Dermatology.

Please cite this article in press as: M. Sachdeva, et al., Cutaneous manifestations of COVID-19: Report of three cases and a review of literature, J
Dermatol Sci (2020), https://doi.org/10.1016/j.jdermsci.2020.04.011
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2 M. Sachdeva et al. / Journal of Dermatological Science xxx (2019) xxx–xxx

5. Methods . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
6. Results . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
7. Discussion . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Funding . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
References . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

1. Introduction macular hemorrhagic rash on the legs (Fig. 2b). Naso-pharyngeal

swab tested for SARS-CoV-2 RNA amplification were positive. No
As of April 20th, 2020, COVID-19 (severe acute respiratory signs of pneumonia were found on the chest x ray. Treatment
syndrome coronavirus 2 [SARS-CoV-2] or, previously called 2019- consisted of antiviral therapy using lopinavir/ritonavir and
nCoV) initially reported in Wuhan, China [1] has been diagnosed in hydroxychloroquine and subcutaneous low molecular weight
more than 2.4 million people worldwide [2]. The high rate of heparin. Gradual spontaneous improvement of skin lesions
infectivity, low virulence and asymptomatic transmission have appeared.
resulted in its rapid spread across geographic boundaries, leading
to a pandemic [3]. The outbreak of COVID-19 has been declared a 4. Case 3
Public Health Emergency of International Concern by the World
Health Organization (WHO) and presents a great challenge for the A 72-year-old Caucasian woman, otherwise healthy, presented
health care communities across the globe [4]. to the Emergency Department in Milan with headache, arthralgia,
SARS-CoV 2 is an enveloped virus composed of positive sense myalgia and fever. Four days later, a papular-vesicular, pruritic
single-stranded RNA and belongs to the coronavirus family. [1] The eruption appeared on sub-mammary folds, trunk and hips (Fig. 3).
virus enters cells through the angiotensin converting enzyme 2 Laboratory examination conducted revealed mild increase in WBC,
(ACE2) receptor, found on the surface of cells [1]. The lungs are the C-reactive protein and erythrosedimentation rate (ESR). COVID-19,
primary site of infection for COVID-19, with patients presenting tested with naso-pharyngeal swab, was positive. Chest X ray was
symptoms ranging from a mild flu-like symptoms to fulminant negative for pneumonia. Complete remission of both general and
pneumonia and potentially lethal respiratory distress [5]. cutaneous manifestations was observed approximately ten days
Interestingly, there have been many COVID-19 cases reporting after the beginning of the clinical picture.
cutaneous manifestations [6–23]. The purpose of this article is to
report three relevant cases and provide a literature review of 5. Methods
various cutaneous manifestation in patients with COVID-19.
A literature search was conducted using PubMed, OVID and
2. Case 1 Google search engines for original and review articles published
since the onset of the current COVID-19 epidemic to April 20, 2020.
A 71-year-old Caucasian woman presented to the Emergency Search terms “COVID-19”, “2019-nCoV”, “SARS-CoV-2” and “coro-
Department in Milan, complaining of fever, productive cough and navirus” were used in combination with “skin”, “dermatology”,
worsening shortness of breath which started 10 days before. The “cutaneous”, “urticaria” and “rash”. We also performed extensive
patient was otherwise healthy with no co-morbidities, medica-
tions or previous adverse drug reactions. She was living in Milan
with her husband, who was diagnosed with COVID-19. Laboratory
tests revealed a normal white blood cells and platelet count (WBC
6470/mm, PLT 290.000/mmc), normal liver and kidney function
and an increased C-reactive protein (49.4 mg/L). Blood cultures
were negative. Bilateral interstitial pneumonia was found on chest
x-ray. Naso-pharyngeal swab tested for SARS-CoV-2 RNA amplifi-
cation resulted positive. She was admitted to the Infectious Disease
Department and started off-label antiviral therapy with lopinavir/
ritonavir and hydroxychloroquine, following Italian Society of
Infectious and Tropical Diseases (SIMIT) guidelines and empiric
antibiotic therapy with third generation cephalosporin (ceftriax-
one). Other drugs administered during hospitalization were:
rabeprazole, paracetamol, metoclopramide, dihydrocodeine, lac-
tulose and subcutaneous low molecular weight heparin. In the
subsequent days, she promptly recovered: she never had fever, we
have been able to gradually decrease oxygen flow and on the 30th of
march, antiviral and antibiotic therapies were discontinued. Over
the following days a maculo-papular itchy rash appeared on the
trunk resembling a Grover disease (Fig. 1).

3. Case 2

A 77-year-old Caucasian woman was admitted to the hospital in

Milan, due to neck lymphonodal enlargement, fever, cough and
diffuse maculopapular exanthem (morbilliform) on the trunk
(Fig. 2a). One day later during hospitalization, she also developed Fig. 1. Cutaneous manifestation of COVID-19 in Case 1.

Please cite this article in press as: M. Sachdeva, et al., Cutaneous manifestations of COVID-19: Report of three cases and a review of literature, J
Dermatol Sci (2020), https://doi.org/10.1016/j.jdermsci.2020.04.011
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M. Sachdeva et al. / Journal of Dermatological Science xxx (2019) xxx–xxx
Fig. 2. (a) Cutaneous manifestation of COVID-19 on trunk in Case 2. (b) Cutaneous
manifestation of COVID-19 on legs in Case 2.
Fig. 3. Cutaneous manifestation of COVID-19 in Case.
hand searching of reference lists of relevant papers and reports.
The studies that did not mention cutaneous symptoms or did not
include any relevant information in the English language were
excluded.
We extracted the following data from included studies: author,
publication year, region, number of participants with skin signs,
age, sex, suspected or confirmed status for COVID-19, cutaneous
signs and its location, timeline and healing duration, associated
symptoms, correlation with COVID-19 severity with skin lesions
and treatments for COVID-19 infection. When extracting informa-
tion from the studies, pairs of researchers conferred to compare
findings and reach consensus. Where consensus was not reached,
an independent researcher was consulted. We also searched for
grey literature including advisories from professional societies,
expert commentaries, blogposts, magazine articles, newspaper
articles and social media posts to retrieve relevant information.
The information from grey literature was not included in the
results section, however, it has been summarized in the
Supplemental File 1.
6. Results
Eighteen articles and three additional cases (reported in this
review) that met the aforementioned inclusion criteria were
summarized in this review. All studies were published during
February and April 2020, with 61.1% of articles published in April.
There are 6 case series [6–9,16,20], and 12 case reports [10–15,17–
19,21–23]. The mean patient age was 53.6 years, with patients
between 15 days and 84 years of age. Males accounted for 38.9% of
reported cases, females accounted for 27.8% of cases, and the sex of
37.5% cases was not reported. In terms of COVID-19 diagnosis, 2.8%
Please cite this article in press as: M. Sachdeva, et al., Cutaneous manifestations of COVID-19: Report of three cases and a review of literature, J
Dermatol Sci (2020), https://doi.org/10.1016/j.jdermsci.2020.04.011
3
patients were suspected cases and 97.2% were confirmed cases.
Table 1 summarizes the cases with COVID-related cutaneous
manifestations in the included articles.
A generalized macular or maculopapular exanthem (morbilli-
form) appeared to be the most common cutaneous manifestation
in COVID-19, with 36.1% (26/72) of patients presenting such lesions
on their skin. A papulovesicular rash (vesicles) was seen in 34.7%
(25/72) of patients. Urticaria occurred in 9.7% (7/72) of reported
patients, and the presence of painful acral red purple papules with
or without vesicles was seen in 15.3% (11/72) of patients overall.
Lastly, 2.8% (2/72) presented with livedo reticularis lesions, and 1
patient (1.4%) presented with petechiae. Of the 72 cases, lesion
location was reported in 67 patients, with the majority of lesions
being found on the trunk, hands and feet. Overall, 69.4% (50/72) of
patients experienced lesions on the trunk. Additionally, 19.4% (14/
72) of patients experienced cutaneous manifestations in the hands
and feet.
The timing of skin lesion development ranged between
patients, from development 3 days before COVID-19 diagnosis to
13 days after diagnosis. In the examined cases, 12.5% (9/72) of
patients presented with cutaneous lesions at diagnosis or onset of
COVID-19 symptoms, while 69.4% (50/72) of patients presented
with lesions after the onset of respiratory symptoms or of COVID-
19 diagnosis. The timing of skin lesion development was not
reported in 18.1% (13/72) of patients. Of the 49 patients who
developed lesions after respiratory symptom onset or of COVID-19
diagnosis, 74.0% (37/50) developed cutaneous pathology within 7
days, and 6.0% (3/50) reported lesions after 7 days. Of the 50 cases
with reported healing times, 100% of patients reported healing of
cutaneous lesions, with healing times up to 10 days. 48.0% of
lesions healed within 7 days (24/50) and 50.0% of lesions healed
after 7 days (25/50), and healing time was unspecified for one case
(2.0%).
Five studies reported on the possible association between
COVID-19 and skin lesion severity in 23 patients. In 21 patients
(91.3%), the severity of cutaneous lesions was unlikely to be or was
not correlated with COVID-19 severity. Contrarily, in 2 separate
reports by Mahé [13] and Estébanez [15], COVID-19 and skin lesion
severity were linked in 2 patients (8.7%). Also, in most of the
included studies, histological findings were not reported.
7. Discussion
Dermatologic manifestations of COVID-19 are rare, with
common clinical features including fever, dry cough, shortness
of breath, myalgia and fatigue seen in relatively large-scale case
studies of COVID-19 pneumonia patients [12,24–26]. Skin man-
ifestations were reported only in case reports and two case series.
In this review, we summarized the information of all the 72 COVID-
19 patients with cutaneous manifestations, as reported in the
literature (Table 1).
The most prominent case study of cutaneous manifestations of
COVID-19 published by Recalcati et al. [7] in Lombardy, Italy
included 88 patients. In this study, 20.4% of the confirmed COVID-
19 patients (18/88) had developed cutaneous manifestations. It
was found that most cutaneous presentations were erythematous
rash (77.8% or 14/18) with few cases of urticaria (16.7% or 3/18) and
vesicle formation (5.6% or 1/18). These findings reflect a similar
distribution of cutaneous manifestations as seen in our review.
Cutaneous manifestations are important in the diagnosis of
various infectious diseases, such as toxic shock syndrome,
meningococcemia, rickettsial diseases, measles, and scarlet fever
[27–31]. As COVID-19 has a tendency to produce asymptomatic
cases for up to 14 days after infection, cutaneous manifestations
may serve as an indicator of infection, aiding in timely diagnosis. In
this review, 12.5% (9/72) of patients presented with cutaneous
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Table 1
Dermatol Sci (2020), https://doi.org/10.1016/j.jdermsci.2020.04.011
Please cite this article in press as: M. Sachdeva, et al., Cutaneous manifestations of COVID-19: Report of three cases and a review of literature, J

Characteristics and cutaneous manifestations of suspected and confirmed COVID-19 cases published in scientific literature.

Author, Region Patients Age, Sex Suspected Cutaneous Manifestations

Publication with or
Year Skin Confirmed
Signs (n) COVID-19
Signs (n) Location Timing Associated Symptoms Healing Correlation Treatments for COVID-19
Duration of COVID-19 Infection
Severity with
Skin Lesions
Gianotti, Milan, Italy 5 Cases 1, Case 1-5: C Case 1: Exanthema Case 1: Trunk and NR NR NR NR NR
2020 [6] 2, 4, 5: limbs
NR, NR
Case 3: Case 2: Purpuric maculo- Case 2: NR
NR, M papulo-vesicular rash
Case 3: Papular Case 3, 4, and 5:
erythematous exanthema Trunk

M. Sachdeva et al. / Journal of Dermatological Science xxx (2019) xxx–xxx

Case 4 and 5: Diffuse
maculopapular eruption
clinically suggestive for
Grover disease
Recalcati, Lombardy, 18 NR C Erythematous rash (14), Trunk 8 developed at onset, 10 Little to no itching Healed within No NR
2020 [7] Italy Widespread urticaria (3), after hospitalization a few days correlation
chickenpox-like vesicles (1) seen with
disease
severity
Manalo Atlanta, 2 Case 1: Case 1,2: C Case 1: Transient non- Case 1: Right Case 1: Symptoms began 7 Case1,2: NR Case 1: 19 NR NR
2020 [8] Georgia 67, M pruritic blanching anterior thigh days after initial onset of hours
unilateral livedoid patch COVID-19 symptoms, 3 (eruption)
resembling livedo days prior COVID-19
reticularis diagnosis
Case 2: Case 2: Unilateral Case 2: Right leg Case 2: 10 days after testing Case 2: 20
47, F asymptomatic rash positive for COVID-19 minutes
resembling livedo
reticularis
Zhang 2020 Wuhan, 7 Median C Acro-ischemia Extremities Median time 19 days (11-23 NR NR NR Low molecular weight
[9] China age of presentations including days) heparin treatment
59, 4 M/ finger/toe cyanosis, skin
3F bulla and dry gangrene
Joob 2020 Thailand 1 NR, NR C Skin rash with petechiae NR NR None NR NR NR
[10]
Jimenez Madrid, 1 84, F C Erythemato-purpuric, Flexural regions, 3 days of hospitalization, 11 NR NR Unlikely Hydroxychloroquine
2020 [11] Spain millimetric, coalescing peri-axillary days since onset and lopinavir/ritonavir
macules
Hunt 2020 New York, 1 20, M C Diffuse, morbilliform, Trunk and Along with fever, before NR NR NR NR
[12] USA maculopapular, and extremities sparing diagnosis
nonpruritic rash the face
Mahé 2020 Colmar, 1 64, F C Erythematous rash Antecubital fossa, Four days after fever NR Day 9 of Yes Paracetamol
[13] France then to the trunk disease
and axillary folds
Fernandez Madrid, 1 32, F C Urticariform rash NR 6 days after the onset of None Improvement NR Hydroxychloroquine
2020 [14] Spain symptoms in 5 day- and azithromycin
period
Estébanez Spain 1 28, F C Pruritic lesions/ Confluent Heel 13 days after being Lesions persisted and 10 days Yes Paracetamol
2020 [15] erythematous-yellowish diagnosed became erythematous
papules plaques that were both
hardened and pruritic
Zhang 2020 Wuhan, 2 57 years C Urticaria NR NR NR NR Unlikely NR
[16] China (25-87),
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69F
Henry 2020 Orléans, 1 27, F C Disseminated Face, hand and feet 48 hours before onset of Pruritis NR NR Paracetamol and
[17] France erythematous plaques (acral involvement) respiratory symptoms antihistamines
eruption, urticaria
Kamali Tehran, 1 15- C Cutaneous mottling NR NR NR 2 days after NR Proper fluid therapy,
Aghdam Iran. days, M entering oxygen therapy, anti-
2020 [18] hospital. biotic therapy by
Vancomycin (10 mg/kg/
q8h) and Oseltamivir (3
mg/kg/12 h)
Mazzotta Italy 1 13, M S Erythemato-violet, Plantar surface of NR Intense itching and After a few NR NA
2020 [19] rounded lesions of 5-15 1st right toe and burning on the foot days
mm in diameter, with dorsal surface of the lesions
blurred limits 2nd toe on both feet
Alramthan Qatar 2 Case 1: C Case 1,2: Acral ischemic Case 1,2: Dorsal NR NR NR NR NR
2020 [20] 27, F lesions presenting as red- aspect of fingers
Case 2: purple papules bilaterally

M. Sachdeva et al. / Journal of Dermatological Science xxx (2019) xxx–xxx

35, F
Najarian New 1 58, M C Erythematous macules Legs, thighs, 1 day after onset of Pain in legs and hands 1 day NR Azithromycin (500 mg
2020 [21] Jersey, USA with islands of normal forearms, arms, respiratory symptoms first day, 250 mg 4
appearing skin between shoulders, back, days), benzonatate 100
them, arranged in a chest, abdomen mg every 6 hours
morbilliform pattern
Kolivras Brussels, 1 23, M C Violaceous, infiltrated Dorsal aspect of 3 days after onset of Pain NR NR NR
2020 [22] Belgium plaques on an toes and lateral respiratory symptoms
erythematous background sides of feet
Marzano Italy 22 Median C Varicella-like Trunk, limbs Median latency time from Itching (n = 9) Median NR NR
2020 [23] age 60, papulovesicular exanthem systemic symptoms to duration was
16 M/6F exanthem was 3 days 8 days (range
(range of -2 to 12 days) 4 to 15 days)
Present Milan, Italy 1 71, F C Maculo-papular itchy rash Trunk Within days of Itching NR NR Lopinavir/ritonavir and
Case 1 resembling Grover disease discontinued treatment hydroxychloroquine.
Other administered
drugs include:
rabeprazole,
paracetamol,
metoclopramide,
dihydrocodeine,
lactulose and
subcutaneous low
molecular weight
heparin.
Present Milan, Italy 1 77, F C Diffuse maculopapular Trunk, legs First dermatological NR Progressive NR Lopinavir/ritonavir and
Case 2 exanthem (morbilliform), examination revealed healing seen hydroxychloroquine
macular hemorrhagic rash guttate psoriasis, with and subcutaneous low
symptoms presenting four treatment molecular weight
days later, lesions heparin
presenting five days later
Present Milan, Italy 1 72, F C Papular-vesicular, pruritic Sub-mammary 4 days after onset of NR 10 days after NR NR
Case 3 eruption folds, trunk, hips symptoms onset

NR: not reported; M: male; F: female; y: years; S: suspected case; C: confirmed case.

5
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lesions at onset. Furthermore, physicians’ awareness of the
cutaneous symptoms related to COVID-19 infection is critical in
preventing misdiagnosis of disease, such as the misdiagnosis of
dengue as reported by Joob et al. [10]
The mechanisms of COVID-19 cutaneous disturbances are not
yet well known, but some common theories are prevalent. It can be
postulated that the viral particles present in the cutaneous blood
vessels in patients with COVID19 infection could lead to a
lymphocytic vasculitis similar to those observed in thrombophilic
arteritis induced by blood immune complexes that activate
cytokines. Keratinocytes may be a secondary target after Langer-
hans cells activation, inducing a spectrum of different clinical
manifestation [6,32]. It can be postulated that the virus does not
target the keratinocyte, but rather immune response to infection
leads to Langerhans cells activation, resulting in a state of
vasodilation and spongiosis [32]. Further theories suggest livedo
reticularis-resembling manifestations can result due the accumu-
lation of microthromboses originating in other organs, thus
reducing blood flow to the cutaneous microvasculature system
[8]. Similarly, low grade disseminated intravascular coagulation
and hypoxia-related accumulation of deoxygenated blood in
venous plexes may further explain such manifestations [8].
Additionally, pauci-inflammatory thrombogenic vasculopathy
with deposition of C5b-9 and C4d as well as co-localization of
these with COVID-19 spike glycoproteins was reported by Magro
et al. [33]. It is still unclear whether cutaneous symptoms are a
secondary consequence of respiratory-related infection or a
primary infection of the skin itself. It is more likely that a
combination of such mechanisms is responsible for the cutaneous
manifestations found in COVID-19+ individuals.
There are several limitations that must be considered for this
literature review. Firstly, the small sample size used in this analysis
restricts the ability to draw strong conclusion applicable to whole
populations. Additionally, since scientific understanding of COVID-
19 and associated dermatological symptoms is currently evolving at
this stage, the information contained in this review is based mainly
on the limited early experience with COVID-19. Due to limitations in
the availability of COVID-19 literature, the recency of the COVID-19
outbreak, and language-related exclusion criteria, this paper only
examines 72 cases of COVID-19 related cutaneous pathologies.
Lastly, we must take into account the possibility of dermatologic side
effects experienced from medications used by participants.
Given the current collection of evidence, it is suggested that COVID-
19 can have dermatological manifestations. As a result, physicians
should be aware of these important clinical manifestations that may
aid in the timely diagnosis of COVID-19 infection. However, further
literature and research is required to validate and elucidate an
understanding of COVID-19 related cutaneous manifestations.
Funding
None.
Declaration of Competing Interest
None. The authors have no conflict of interest to declare.
Acknowledgements
None.
Appendix A. Supplementary data
Supplementary material related to this article can be found, in the
online version, at doi:https://doi.org/10.1016/j.jdermsci.2020.04.011.
Please cite this article in press as: M. Sachdeva, et al., Cutaneous manifestations of COVID-19: Report of three cases and a review of literature, J
Dermatol Sci (2020), https://doi.org/10.1016/j.jdermsci.2020.04.011
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